门冬胰岛素联合口服药控制老年髋部骨折患者高血糖的剂量及安全性

摘要

目的 研究胰岛素泵用门冬胰岛素联合口服药物治疗老年髋部骨折急性期伴高血糖时的剂量及安全性. 方法 1周内发生髋部骨折伴高血糖需要使用胰岛素泵治疗患者依年龄分为老年组(≥65岁,42例)和为非老年组(＜65岁,43例),所有患者均进行严格饮食管理,胰岛素泵给予门冬胰岛素联合口服药物控制血糖,比较达标时门冬胰岛素用量及使用过程中患者出现的不良事件.结果 老年组、非老年组达标时每公斤体质量基础门冬胰岛素用量分别为(0.29±0.09) IU/kg和(0.30±0.07) IU/kg,餐前追加量分别为(0.27±0.09) IU/kg和(0.27±0.07) IU/kg;无症状低血糖分别为14.3％和18.6％;有症状低血糖分别为4.8％和4.7％;伴有意识障碍的低血糖、过敏反应、出现伤口不愈或延迟愈合者二组均未发生;联合应用的口服药物包括二甲双胍、格列美脲及糖苷酶的抑制剂,使用比率在两组间均无差别. 结论 严格的饮食控制联合口服药物,门冬胰岛素经胰岛素泵可控制老年髋部骨折急性期患者高血糖,安全性良好.%Objective To investigate the dosage and safety of insulin aspart in continuous subcutaneous insulin infusion plus oral antidiabetic drugs for the treatment of hyperglycemia in elderly hip fracture.Methods Patients with hip fracture and hyperglycemia who required insulin pump therapy were divided into 2 groups according to age:elderly group (patients aged over 65 years,n=42) and non-elderly group (patients aged under 65 years,n=43).All patients were treated with insulin aspart in continuous subcutaneous insulin infusion plus oral antidiabetic drugs combined with diet therapy.Dosages of aspart insulin and adverse effects were compared between the two groups.Results There were no significant differences in basic aspart dosage and additional premeal dosage between elderly and non-elderly groups [(0.29±0.09) IU/kg vs.(0.30±0.07) IU /kg,(0.27±0.09) IU/kg vs.(0.27±0.07) IU/kg,both P＞0.05].The incidences of hypoglycemia with and without symptoms in elderly versus non-elderly groups were 4.8％ vs.4.7％ and 14.3％ vs.18.6％,which had no significant differences between the two groups (P＞0.05).Hypoglycemia accompanied by consciousness disorders,allergy,nonhealing and slow healing wounds were not found in the two groups.The ratio of oral antidiabetic drugs including metformin,glimepiride,and glycosidase inhibitor had no differences between the two groups.Conclusions Aspart insulin in continuous subcutaneous insulin infusion is effective and safe in the treatment of acute severe hyperglycemia in elderly patients with hip fractures when combined with diet therapy and oral antidiabetic drugs.